Abstract
Background
We have recently developed a microscope-integrated spectral-domain optical coherence tomography (MIOCT) device towards intrasurgical cross-sectional imaging of surgical maneuvers. In this report, we explore the capability of MIOCT to acquire real-time video imaging of vitreoretinal surgical maneuvers without post-processing modifications.
Methods
Standard 3-port vitrectomy was performed in human during scheduled surgery as well as in cadaveric porcine eyes. MIOCT imaging of human subjects was performed in healthy normal volunteers and intraoperatively at a normal pause immediately following surgical manipulations, under an Institutional Review Board-approved protocol, with informed consent from all subjects. Video MIOCT imaging of live surgical manipulations was performed in cadaveric porcine eyes by carefully aligning B-scans with instrument orientation and movement. Inverted imaging was performed by lengthening of the reference arm to a position beyond the choroid.
Results
Unprocessed MIOCT imaging was successfully obtained in healthy human volunteers and in human patients undergoing surgery, with visualization of post-surgical changes in unprocessed single B-scans. Real-time, unprocessed MIOCT video imaging was successfully obtained in cadaveric porcine eyes during brushing of the retina with the Tano scraper, peeling of superficial retinal tissue with intraocular forceps, and separation of the posterior hyaloid face. Real-time inverted imaging enabled imaging without complex conjugate artifacts.
Conclusions
MIOCT is capable of unprocessed imaging of the macula in human patients undergoing surgery and of unprocessed, real-time, video imaging of surgical maneuvers in model eyes. These capabilities represent an important step towards development of MIOCT for efficient, real-time imaging of manipulations during human surgery.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Dayani PN, Maldonado R, Farsiu S, Toth CA (2009) Intraoperative use of handheld spectral-domain optical coherence tomography imaging in macular surgery. Retina 29:1457–1468
Baranano DE, Fortun JA, Ray R, Charkoudian L, Bergstrom C, Cribbs B, Schwent B, Hubbard G, Srivastava S (2010) Intraoperative spectral-domain optical coherence tomography for macular pucker surgery. ARVO Meeting Abstracts 51:269
Lee LB, Srivastava SK (2011) Intraoperative spectral-domain optical coherence tomography during complex retinal detachment repair. Ophthalmic Surg Lasers Imaging 42 Online: e71–e74
Ray R, Baranano DE, Fortun JA, Schwent BJ, Cribbs BE, Bergstrom CS, Hubbard GB 3rd, Srivastava SK (2011) Intraoperative microscope-mounted spectral-domain optical coherence tomography for evaluation of retinal anatomy during macular surgery. Ophthalmology 118:2212–2217
Wykoff CC, Berrocal AM, Schefler AC, Uhlhorn SR, Ruggeri M, Hess D (2010) Intraoperative OCT of a full-thickness macular hole before and after internal limiting membrane peeling. Ophthalmic Surg Lasers Imaging 41:7–11
Scott AW, Farsiu S, Enyedi LB, Wallace DK, Toth CA (2009) Imaging the infant retina with a hand-held spectral-domain optical coherence tomography device. Am J Ophthalmol 147(364–373):e362
Hahn P, Migacz J, O'Connell R, Maldonado R, Izatt JA, Toth CA (2011) The use of optical coherence tomography in intraoperative ophthalmic imaging. Ophthalmic Surg Lasers Imaging 42:S85–S94
Han S, Sarunic MV, Wu J, Humayun M, Yang C (2008) Handheld forward-imaging needle endoscope for ophthalmic optical coherence tomography inspection. J Biomed Opt 13:020505
Balicki M, Han JH, Iordachita I, Gehlbach P, Handa J, Taylor R, Kang J (2009) Single fiber optical coherence tomography microsurgical instruments for computer and robot-assisted retinal surgery. Med Image Comput Comput Assist Interv 12:108–115
Binder S, Falkner-Radler CI, Hauger C, Matz H, Glittenberg C (2011) Feasibility of Intrasurgical spectral-domain optical coherence tomography. Retina 31:1332–1336
Tao YK, Ehlers JP, Toth CA, Izatt JA (2010) Intraoperative spectral-domain optical coherence tomography for vitreoretinal surgery. Opt Lett 35:3315–3317
Ehlers JP, Tao YK, Farsiu S, Maldonado R, Izatt JA, Toth CA (2011) Integration of a spectral-domain optical coherence tomography system into a surgical microscope for intraoperative imaging. Invest Ophthalmol Vis Sci 52:3153–3159
Tao YK, Ehlers JP, Toth CA, Izatt JA (2011) Visualization of vitreoretinal surgical manipulations using intraoperative spectral-domain optical coherence tomography. Proc SPIE 7889:78890F
Spaide RF, Koizumi H, Pozzoni MC (2008) Enhanced depth imaging spectral-domain optical coherence tomography. Am J Ophthalmol 146:496–500
Acknowledgments
The authors would like to acknowledge Katrina Winters and Michelle McCall for their administrative assistance, along with Tomas Moreno and Eric Yuan for their technical assistance.
Author information
Authors and Affiliations
Corresponding author
Additional information
Supported by the Heed Ophthalmic Foundation (PH), NIH: 1UL1 RR024128-01; 1R21 EY019411
Dr. Toth receives research support through equipment loan from Bioptigen, and has potential for royalties for OCT-related technology licensed by Duke to Bioptigen. Dr. Toth also receives royalties for surgical technology licensed by Duke to Alcon Laboratories. Duke University has an equity interest in Bioptigen.
Dr. Izatt is a co-founder of Bioptigen, Inc., and has corporate, intellectual property, and equity interests in this company.
Rights and permissions
About this article
Cite this article
Hahn, P., Migacz, J., O’Connell, R. et al. Unprocessed real-time imaging of vitreoretinal surgical maneuvers using a microscope-integrated spectral-domain optical coherence tomography system. Graefes Arch Clin Exp Ophthalmol 251, 213–220 (2013). https://doi.org/10.1007/s00417-012-2052-2
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00417-012-2052-2